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Morgan Stanley 24th Annual Global Healthcare Conference

Sep 16, 2026

Summary

Strong demand for IBSRELA and XPHOZAH drives robust revenue growth, with profitability expected in 2027 and IP protection to 2042. Strategic focus includes expanding indications, optimizing specialty pharmacy distribution, and disciplined capital allocation. The company is set for sustained cash generation, minimal dilution, and multiple product launches by decade's end.

Bob Klingenberger
Executive Director, Morgan Stanley

Great. Good morning, everyone. My name is Bob Klingenberger. I am with Morgan Stanley. Before we start with the Ardelyx team, which we are very excited to have here, just want to direct everyone to our research disclosures at morganstanley.com/researchdisclosures. If you have any questions, reach out to your Morgan Stanley representative. Very excited this morning to have Mike Raab, CEO, and Sue Hohenleitner, CFO from Ardelyx, joining us. Welcome. I think just to kind of kick things off, Mike, maybe starting with you. Obviously, the company has. There is a lot that has happened over the last couple of years, moving kind of commercial stage and launching two products. Maybe just to start us off, how would you characterize where the company stands today and kind of reflecting on some of the progress over the last couple of years?

Mike Raab
CEO, Ardelyx

Sure. Bob, thank you, and thanks, Morgan Stanley, for inviting us today. It has been certainly a journey for all of us getting to where we are. I guess the way I describe where we are in our journey is what we all aspire to do. We ultimately get into this business to develop drugs and ultimately help people who have needs that are not being met by the current medicines on the market. We have the good fortune of having two on the market, one for IBS-C, IBSRELA, and the other for hyperphosphatemia for patients on dialysis, XPHOZAH. We are on a path right now to generate this year close to half a billion dollars of revenue. As we have said in our last earnings, we are on a path to be profitable in 2027.

With that cash that we are going to generate is going to be the next evolution of a chapter of Ardelyx as we in-license and look at extending the life cycle for particularly IBSRELA when we are running our chronic idiopathic constipation trial. The reason we are doing this work is if you look at the intellectual property that we have built, we have a runway now to 2042. So the ability that we have to create additional value for both of these programs is evident in the investments that we are making. So, we are just at the start, frankly. If you look at 2042 being the timeframe before we have expiry of our intellectual property, there is a lot of time to build substantive value, and help the many, many patients, both with IBS-C and with hyperphosphatemia.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. You mentioned, right, kind of your guidance for the year and the strong ongoing kind of demand for both IBSRELA and XPHOZAH. Maybe just kind of talk us through some of the comments you made in your last earnings around the payer environment and.

Mike Raab
CEO, Ardelyx

Sure

Bob Klingenberger
Executive Director, Morgan Stanley

how you adjusted some of the recent guidance.

Mike Raab
CEO, Ardelyx

Yeah. I will ask Sue to comment on this as well. But one of the things when we launched is we said there is going to be an opportunity coming for negotiations and discounting to payers. We started without it because frankly, as we described, we could have given every single penny of profit away and not had a better position, which was non-formally non-preferred. We have now gotten noticed, and I think that was really the genesis of the re-guide that we did earlier this year was based upon the pressures that payers do. That is their job and the business that they are in. They were putting hurdles in front of patients in order to get a prior authorization approved.

Just based upon those dynamics, as we looked at it, we felt it was a responsible thing to do to back off from the guide that we do, reframe the business as it was going forward, as we start this process with our payers, and feel very good about the guides that we have given both for IBSRELA and XPHOZAH, and the opportunity ahead. Sue?

Sue Hohenleitner
CFO, Ardelyx

Yeah. I mean, the only thing I would add is the guidance for the rest of the year does not reflect that any of those payer pressures are going to be eased off. We know that these talks take a little time, and we will look to do something in 2027 likely. But we have started the talks, and I think really, as Mike said, what we want to do is make sure that patients and physicians can prescribe and know that their patients will get the product.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. I think importantly, as part of that, you sort of maybe specifically on IBSRELA, the sort of greater than $1 billion peak guidance. Maybe just help walk us through the funnel to get down to that number and the different components giving you confidence in that longer-term outlook.

Sue Hohenleitner
CFO, Ardelyx

Yeah. I will start in terms of the financial piece of that. When we think about our guide for this year and the revision of $350 million to $370 million for IBSRELA, that represents at the mid about a 31% growth rate. When you think about the path to a billion dollars, initially in 2029, that would have assumed about a 38% CAGR. So we knew right now growing at 31%, to be able to grow at 38% just felt like that is a little much right now without a huge catalyst. Obviously, CIC is a great catalyst, but not something that is going to really measurably impact 2029, just given when we expect approval. So we decided let us decouple the timing with the billion. We still firmly believe in the billion. It just may be a little bit longer than that. So

Mike Raab
CEO, Ardelyx

I think also for the context is the hurdles are ultimately at the bottom of the funnel, and the demand at the top of the funnel is incredibly strong.

Right? I mean, what we hear from the field and prescribing physicians, we get zero pushback on the clinical value proposition on any of the things and the benefit it provides the patient, which is one of the reasons we have also put in place the beginning of the IBSRELA Pharmacy Network, the IPN as we refer to it. The reason we do that is if you look at where the vast majority of IBS-C prescriptions historically have gone through is through a retail pharmacy. I do not know if you have been in a retail pharmacy recently, but if you look at it, roughly 90% of their prescriptions are generics. They are not set up given the amount of time it takes for prior authorizations.

To move our prescriptions out of retail and into the specialty network allows for a higher touch. Our data says that there's at least one to two additional prescriptions that are filled, so refills, that go through the IPN versus retail. It's a strategic move that, frankly, had I to do it over again, we probably would've only launched with a specialty pharmacy network because of the high abandonment rate through the funnel of scripts that go through retail. There's, in the dynamics that are happening in our business, the need for any new drug that has a kind of value proposition in a space that has an incredibly successful set of competition like LINZESS. That is retail. You need to have a strategy where you begin to have that high touch.

Prior authorizations for new medicine is just the name of the game, and retail is not set up for it. The IPN is a huge part of it, and that transition from retail into the IPN is also part of the genesis of the re-guide that we made.

Bob Klingenberger
Executive Director, Morgan Stanley

Mm-hmm. Yeah, and I think, Mike, I've heard you in the past, I think, talk through to the kind of the broader market and the how many patients, and kind of what does $1 billion kind of more or less mean.

Mike Raab
CEO, Ardelyx

Sure. Right. If you look at the IBS-C indicated market is roughly 8 million prescriptions written a year. It is an incredibly sizable market. The epi on it is roughly 13 million people in this country have IBS-C. For us to get to $1 billion, it's south of 10% share, right? So it is a relatively small share to get to that billion. It is actually, as Sue pointed out, it is the growth rate that had us back off the timing of the billion, not the absolute number, because of these challenges that the paying environment puts in place. Our job is to eliminate that friction as much as we possibly can.

Now, we could give every penny away of profit, which we obviously would not do, and we would not have a much better position than we have now, simply because of the volume of whether it is generic lubiprostone or where we are with LINZESS in terms of the price. They cut the WAC price in half in the fourth quarter, and they have done their IRA negotiation. It is a basically generic market that we are competing against. That is the dynamic. For us to get to the billion, as you look at it, is less than approximately 10% the market share or thereabouts, that get us to that $1 billion. I think as we have shared before, of those writers, there is probably 200,000 writing HCPs. We call on the top 50%, which is only 14,000. That is why we have a sales organization of roughly 144.

It is about 100 HCPs per salesperson, and that is the way we have scaled it, is to call on that 50%. The other 182,000, we are not going to call on those.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. Yeah, and you made reference, right, to just the broader IBS-C market. It is obviously a competitive space and as you are positioning, you mentioned some of the plan on the sales force side. But as you are positioning IBSRELA with physicians and patients, what are some of the key kind of differentiators and just in terms of that go forward. You talked a little bit about the specialty pharmacy network, but just kind of go forward commercial.

Mike Raab
CEO, Ardelyx

It is interesting, if you look at the history of IBS-C, it is basically one class of drugs, historically, it has been secretagogues. You have the two GC-C agonists, then you have AMITIZA. So one very basic difference between us and all those others is different mechanism of action. We are an inhibitor that blocks NHE3. So that is one important thing, but what does that actually mean practically for the patient? If you look at the pain benefit and the differentiation between chronic constipation and IBS-C is pain. So you are our physician, Sue and I come into your office, I am constipation without pain, Sue is with pain. I am chronic constipation, which is why we are doing the CIC trial, and IBS-C for Sue.

That is the differentiator to understand one reason why we're doing the CIC trial, but why for IBS-C, the benefit that we have in pain is so critical if you look at our endpoint. Our clinical trial was a first-line therapy trial. We had some patients that had previous experience with the secretagogues, but most were naive. Given we knew how we would be positioned in the market by the payer world, we have taken a position of second, third-line therapy after those other products have been used.

Sue Hohenleitner
CFO, Ardelyx

I think we also know over 70% of patients who are on a secretagogue end up not being satisfied or not working. That is really our market because we aren't competing in first line, we are getting those failures or those people that need it.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. Maybe just sticking with IBSRELA, you mentioned the patent out to 2042, on the formulation. As you think about the path from here to $1 billion beyond, what are driving those growth opportunities, as you think about obviously capturing more share, but just more specifically on what's driving?

Mike Raab
CEO, Ardelyx

I think there are a couple of important levers to think about. One is, as Sue pointed out, the failures on the GC-C agonists, even with the new steps that are in place with people going back to lubiprostone, those patients will ultimately fail. Sadly, we know that with the secretagogues, the vast majority of patients are ultimately going to be unsatisfied with the therapy that they're being given. That's where IBSRELA fits. For us, it is, one, making sure that the physicians and the HCPs understand that their patients will ultimately be dissatisfied with the current therapies that they're on. Two, that there then is a choice. We get zero pushback in terms of clinical benefit and the proposition that we provide.

Third, that if you put your prescription through the IBSRELA Pharmacy Network, the probability is orders of magnitude higher that it will get filled.

It is a change of habit where these physicians, the HCPs, are accustomed to writing a script to retail for an IBS-C drug. It is a change of mind that we are working on to help them understand this is a specialty drug. These are for people that need to be treated better, differently than they historically have. Going through retail and going through GC-C agonists is insufficient. You need to change the frame of mind to say, "Okay, now we need to treat these patients differently," similar to the way they do ulcerative colitis or other things within their offices, which go through specialty. It is actually a mind shift that we are in the midst of working through to say, "Now put your patients through." You are going to have far greater certainty that not only we get the first script filled, but then subsequent refills.

Because the specialty pharmacy will remind you, do all those things. It is a higher touch approach. As we make that transition over the ensuing months, that is going to be an important differentiator between us and the other products. Yeah.

Sue Hohenleitner
CFO, Ardelyx

When I think too about, just to add about the entire life cycle that we have, we are going to be continuing to allocate capital towards life cycle management because we have that long runway. It is something that we are doing as part of our capital allocation plan.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah, that was actually going to be my next question. You mentioned briefly the CIC study you are running, the ACCEL study. Maybe just kind of remind us all the genesis for that, obviously beyond just the 2042, but the unmet need and then the trial that you all are running.

Sue Hohenleitner
CFO, Ardelyx

Yeah, I will start. Basically, all of the other secretagogues are approved for both IBS-C and CIC. When you think about going into a physician, as Mike said before, if one of us has pain and the other doesn't, the physician doesn't have to think about it. For us, we can pursue that indication now just to continue to make it as easy as we can for a physician who's not sure whether pain or discomfort might be included with the constipation. Something we could have done before if we had the capital, and I think now that we do and we can do that study, it's great. We are enrolling now. We are going to do a readout mid-next year and go from there.

Mike Raab
CEO, Ardelyx

For us, the confidence in this, Bob, is-

We are all treating constipation. If you look at IBS-C, it is made up of constipation and pain, as I said. We know what the response rate is, and that was the basis of the design of our CIC trial, was the benefit that we see in the constipation component of IBS-C. If you look at the evolution over time of how the treating world considers chronic constipation for IBS-C, it used to be two pretty distinct groups of people. The reality is they really overlap. It's more than a Venn diagram because you have chronic constipation people that will move, if they're not treated, into IBS-C. You have people on IBS-C that their pain is taken care of, but then they become constipation. They go back and forth.

It is actually a far more fluid indication between the two and the fact that we do not have the ICD-9 code, we do not have the indication for CIC, makes it an extra step for the physician to say, "Oh, gee, I have to write down the ICD-9 code only for IBS-C, because if I do CIC, it will not get through prior authorization unless there is a lot of work on the part of the treater.

Bob Klingenberger
Executive Director, Morgan Stanley

In terms of just sort of the incremental patient opportunity, CIC, how big, relative maybe to IBS-C and

Mike Raab
CEO, Ardelyx

It is a huge market.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

It is massive, right?

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

It is about, compared to the 13 million IBS-C, the epi in CIC is roughly 30 million people.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah

Mike Raab
CEO, Ardelyx

The vast majority of those patients are treated well through over-the-counter medications. Right? Then you have to take a significant haircut there. But those patients with chronic constipation that are actually going to their physician, they are not getting satisfied by over-the-counter medications, so they need a prescription medicine. Is that roughly about the same size as IBS-C, is kind of the way I think about it.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

It is hard if you look at the data for LINZESS in particular, they have two lower doses that are indicated for CIC. The realities are physicians use for IBS-C the lower dose, for CIC the higher dose. So it is hard to use that. It is the best proxy that is out there, and it would tell you that it is roughly the same size.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. And it is really, to your point, to be able to be used for both.

Mike Raab
CEO, Ardelyx

Exactly

Bob Klingenberger
Executive Director, Morgan Stanley

patient sets as they present to the physician.

Mike Raab
CEO, Ardelyx

Yeah.

Bob Klingenberger
Executive Director, Morgan Stanley

Maybe just kind of shifting for a moment to XPHOZAH.

Mike Raab
CEO, Ardelyx

Sure

Bob Klingenberger
Executive Director, Morgan Stanley

your second product. I think there's been a lot of questions, and you all have obviously talked about this a lot in terms of reimbursement and what you've put in place for that program. Maybe just give us the latest on

Mike Raab
CEO, Ardelyx

Sure

Bob Klingenberger
Executive Director, Morgan Stanley

where that stands for XPHOZAH today.

Mike Raab
CEO, Ardelyx

Yeah, taking a step back from it is, I've been in the business for the better part of 25 years in developing and commercializing drugs for hyperphosphatemia for dialysis patients. It is really a hidden population, although all of us live within an hour of a dialysis center, most of us don't know that, is there's 550,000 people in the U.S. that are on dialysis. And one of the things that they have to deal with when their kidneys no longer function is phosphorus. Phosphorus is something with functioning kidneys none of us hear about or think about, but it is an independent predictor of morbidity and mortality in that patient population. We lose 20% of dialysis patients per annum.

For us, the ability to provide a medicine with a new mechanism, has never had anything but binders, is a critically important thing for the well-being of those patients. So when we were launching the medicine, one of the challenges in dialysis is you do end up potentially being in a government-bundled system for payment. We know for new innovative drugs, it is a short life for those medicines because once they finish a period of time when you get qualified to go into the government payment system, the drugs go away. Very good medicines have disappeared that would help these patients. So we made the decision, and it's a controversial one, and certainly provided challenges for everyone to understand, is we would not go into that system.

What that means is the Medicare population, which is roughly 60% of the patients on dialysis, no longer have the same sort of access in terms of through insurance. We have a patient assistance program for those that qualify can get it, but we focus on the Medicaid and the commercial sectors of that patient population, which is 40%. So we focus our commercial efforts or our sales efforts around those two areas. From there is where we've generated all the revenue that you've now seen since this began in 2025. We're coming to the end of what's referred to as the TDAPA period, of that period of time to qualify to be paid for under the government system. I think that will change some of the dynamics for the prescribers, the dialysis organizations, and their engagement with us and XPHOZAH. That will begin in 2027.

Part of what we did at the same time as we re-guided for XPHOZAH as we said, "Hey, listen, with the dynamics that are happening out there, including now a quality measure," which has never been in there in my career of how well you as a dialysis organization are doing in managing phosphorus. That quality measure could be a tailwind. That could help engage physicians, the DOs, dialysis organizations, to do a better job than historically has been done in managing phosphorus. So that's a good thing. But the dynamics as you look at other potential competitors that may or may not choose to play in that system of getting the government payment may add additional confusion and challenges in the market.

We felt it was prudent to step back from the $750 million and say, "We'll come back to you once we see what those dynamics look like," both tailwinds and headwinds, to give the street, both from an investor from a sell side as well, an understanding of what that dynamic looks like. Because it is confusing. It is a different thing. There's no real proxy for what it is that we're doing and help us help them to better understand the market going forward.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah, and I think you referenced the sort of choice not to go in the bundle, have now a couple year experience, TDAPA period. I guess what kind of the learnings, what has maybe surprised you as you guys have gone through that journey the most and the learnings for kind of the forward outlook of the product, which you described a little bit already?

Mike Raab
CEO, Ardelyx

Yeah, it is understandable that from the investor side and the sell side that it is hard to understand. Because we've made a choice to not play with 60% of the market. That seems crazy. But that 60% of the market would never generate the kind of revenue long-term, particularly with 2042 now looming.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

Because you have a finite two-year period of time, and you, by any proxy that's out there, you're going to stop selling the drug after that period in any substantive way. So we decided, as I said, to not play that same sort of game, and find that what we're doing is having a meaningful impact on those patients. We know anecdotally that there are benefits that have come to those patients that you've not seen previously with binders. And that is our value proposition is we are normalizing or helping to normalize or get patients to levels of serum phosphorus that previously they've unable to attain. And for us, that's our true north. And anything that we can do to build this business, our guide is $110 million- $120 million.

in the face of what is happening for the other products in going through the bundle, I am proud of the team and what it is that we are accomplishing there as we look to grow this business continually going forward and beyond in 2042.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. We have gone through the products. Maybe, Sue, this probably pertains to you.

Just looking at the P&L and, Mike, I think you mentioned profitability.

for next year, in 2027. Maybe just talk us through the kind of the components as you think about both the bottom line is probably what you can maybe talk to a little bit more on a qualitative basis.

Sue Hohenleitner
CFO, Ardelyx

Yeah, absolutely. We were excited to be able to declare profitability because I think as we were going through the year, different earnings points and investor conferences, people were asking us and we're like, "Well, it's around the corner. We think we'll get there shortly." I'm proud of the team to be able to say that we will be profitable next year. The way I see that is when you think about our OpEx and what we guided to this year, we said under $500 million is what we'll spend. OpEx has kind of leveled off. There's not a big new sales force we're putting in. We're definitely doing optimization around the edges, but nothing big.

The way I see it, beyond the additional R&D that we're going to continue to invest behind the CIC trial and RDX10531, there's not a measurable increase there for any reason. But we do see sales continuing to go up. Whether it's a CAGR or similar to what we have this year or something else, we know sales are going to grow faster than OpEx. When you think about those components, the math will definitely be there to be profitable. No, go ahead.

Mike Raab
CEO, Ardelyx

What Sue just said for our businesses is an incredibly rare thing.

Sue Hohenleitner
CFO, Ardelyx

Yeah.

Mike Raab
CEO, Ardelyx

I think that is also really an important thing for everyone to really focus on. There aren't many companies that declare profitability in the way that we are. It's a handful per annum that you can see that transition from losing money as we tend to do in this industry for a long time. That threshold that we're crossing right now allows us to generate a lot of free cash. We're basically funding our operations now. That loss is narrowing dramatically over time. With something today that has a gross profit of better than 95%, our ability to then reinvest in the enterprise, whether it is our own innovation, external innovation, the team that's out there doing business development, looking for opportunities across the world, for me, is incredibly exciting because this is what we're supposed to be doing.

We're supposed to build an enterprise that generates its own cash, minimizes dilution to our investors and our shareholders, reinvest those dollars because of the management team and the opportunity that we have here to redeploy that capital. Not many of us get to do this, and that's aspirationally I think what we all want to get to. It's really hard.

It is a long journey, but we're there, right? Our ability with the amount of cash that we generate to do something substantive is, I don't think is well appreciated, one, the journey, and two, what it means in the not too distant future.

Sue Hohenleitner
CFO, Ardelyx

Yeah. I do think too, along with that, we knew this was a day that was coming in a good way, so we did put out our capital allocation plan earlier in the year because we want investors and everyone to understand what are we going to do with that capital. We are already funding our own operations, so it's really all about growing IBSRELA, and continuing to grow that at the best extent we can, investing in life cycle, whether it be internal R&D or the business development that Mike just spoke of. Then the financial discipline, whether it's using our capital to do other things within the business or refinance our debt, which I know you guys were great helps with that early in the year, or anything else we want to do with our capital.

They're kind of our three pillars, for capital allocation, which is going to become very useful for next year when it's-

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. You guys took my next question.

Sue Hohenleitner
CFO, Ardelyx

I know. I was looking at him like, "Oh.

Bob Klingenberger
Executive Director, Morgan Stanley

But I guess maybe just to remind us then, Sue, too, in terms of in the second quarter, kind of where you sit in terms of cash.

Kind of debt and then obviously with the overlay of what you talked about with 2027.

Sue Hohenleitner
CFO, Ardelyx

Yeah, absolutely. We ended second quarter at almost $282 million in cash. We do have a debt out there of about $250 million. We did draw down another tranche of that debt in June for about $50 million. So all in, we have $250 million of debt, with SLR Capital Partners, and then we've got $282 million in cash. So, we continue to feel like that cash flow is going to keep generating, which is great news.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah,

Sue Hohenleitner
CFO, Ardelyx

And about

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. You both brought up sort of the business development aspect of things, right? I guess just how do you think about that from a fit perspective, technology, and maybe a little bit of the therapeutic area overlay as well?

Mike Raab
CEO, Ardelyx

I mean, narrowing into our therapeutic areas makes sense, right? That's a no-brainer that we should always try to look at where we can

at a minimum leverage part of the organization. I think one of the most important things, though, and it is the hallmark of our industry, is the opportunistic look at everything, right? We're going to look at other therapeutic areas because that is critical to do. And our ability, given this team, if I look at the team that's part of this company, everyone has been in multiple therapeutic areas. So it isn't out of the realm of reasonableness to think that we're going to look at things that are not necessarily in our therapeutic areas. We'll look at things that are adjacent to. And one of the examples that we give is hepatology, which is an adjacency to what we do in GI, but we're going to look broad.

Because of the cash we generate, the experiences we broadly have as a team in multiple therapeutic areas, and understanding where we can differentiate as we look at opportunities. And right now we'll look at things that we can afford to do, right? With the cash that we're generating, it's going to be relatively more likely to be preclinical, clinical, early clinical phase I, maybe even phase II, or about to go into phase II, because that's something we can afford to do. Because as you know, many of those things are going to fail, right? That is just the nature of drug development. So you can scale in based on success. If we assume success as we generate more cash, we can afford to do it, right? We can afford to run the clinical work at the same time as we bring earlier stage things in.

As we generate more capital, our ability to do more substantive and sizable deals, transformative deals are certainly on the horizon as well.

Bob Klingenberger
Executive Director, Morgan Stanley

And maybe just kind of piggybacking on that, you obviously have an internal program that I think is probably the one thing we haven't touched on. How does that kind of fit into that overall story that you just said about bringing in assets over time as well?

Mike Raab
CEO, Ardelyx

Yeah. tenapanor is a phenomenal molecule in what it does. I think we've learned and continue to learn more of how it benefits patients. So when we looked at our internal opportunities, RDX10531 was a program that we had started, in the early days as we looked at NHE3 inhibitors. What is really interesting about that molecule, at a very basic level, it is about 10 x more potent, about 30 x more soluble. Why does that matter? Is if you look at potency, it could be lower doses, it could be once a day. If you look at solubility, we do know the pH sensitivity of tenapanor can cause some precipitation in the lower GI. So if you have something that can actually hit NHE3 in the GI tract all the way through the length, that could be a better efficacy profile. It could be once a day.

It could be lower doses. So those are all the things that we would explore going forward. We are in early preclinical, so we've got to follow the science, is if there are things that come out in our preclinical work that say we can't go forward, we obviously wouldn't. But it is a very interesting molecule, which is why we're pursuing it.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. So I think we've covered a lot of the ground and maybe just as we're kind of wrapping up here, what do you feel like is sort of maybe underappreciated about the story, right? I think we've gone through a lot of the nitty-gritty details, but maybe at a high level, what do you feel like maybe folks are not getting with the story?

Mike Raab
CEO, Ardelyx

I don't think people get the story, is the answer. Not to be glib, but there are not a whole lot of companies that look like Ardelyx out there. I think because of that, it's hard to figure out. The guide down from where we were, just to tell you that journey, we grew 74% last year, to almost $274 million. We originally guided to 50% growth, which totally made sense, right? Going from 74% to 50% growth in the original guide was completely appropriate and logical before we got the headwinds of payers. We're still growing greater than 30%.

I don't think people have given us the credit. We certainly are in the doghouse for the re-guide, but we're still growing incredibly well and generating an awful lot of cash, and soon, as we've talked about, to be profitable. I don't think people understand that this is a company that is going to generate money, is going to be able to continue to reinvest in itself, is going to limit dilution dramatically to shareholders. We've not raised capital, dilutive capital in over four years, almost five years now. That is not, I think, appreciated. We've been public since 2014, so I think in some ways out of sight, out of mind. This is a name that I think should be a cornerstone for so many investors because it is predictable. It is going to grow, it is going to generate profit.

We are going to reinvest that money and create even more benefit for patients and our shareholders. I don't think that's well appreciated. The complexity of the stories around XPHOZAH, I get that people don't quite understand it and maybe discount it to zero, but it is contributing and will continue to contribute.

I don't think what I've just described or any of the things that we've talked about this morning are well appreciated or understood by the buy side. I understand it. That's our job. That's why we're here talking to you and meeting with investors today, is I don't think that's sufficiently appreciated, that this should be a component of a portfolio, unlike the high beta that you're going to see with the hope and promise of clinical work where the vast majority fails. We are succeeding, we are winning, and I don't believe that's appreciated sufficiently. I don't see anything to add.

Sue Hohenleitner
CFO, Ardelyx

It's really well said. You saw me nodding the whole time.

Mike Raab
CEO, Ardelyx

Yeah.

Sue Hohenleitner
CFO, Ardelyx

No, I really wouldn't. I do think the sell side, the analysts that cover us, have us much higher than what the stock price would reflect today.

Mike Raab
CEO, Ardelyx

Yeah.

Bob Klingenberger
Executive Director, Morgan Stanley

Well, maybe just as we have a minute left, and I think, Mike, we started off with just the journey a little bit, and I think just looking forward, we talked about it a little bit in terms of what's maybe underappreciated, but as you look forward to the end of the decade and into the next decade, where do you hope we're having this conversation in a couple of years, that we're-

Mike Raab
CEO, Ardelyx

It's easy to talk about the end of the decade.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

It's not that far away.

Bob Klingenberger
Executive Director, Morgan Stanley

No.

Mike Raab
CEO, Ardelyx

Five years out or less, you look at what we can do over these next four years, and whether it's a well-used phrase of a string of pearls that we bring in, that we develop, this is a company that is going to be able to stand on its own. It has the team now in place. If you look at the team over the last 24 months, I've rebuilt my entire management team of people that have just incredibly deep experience in building companies, understanding capital allocation. To be able to talk about capital allocation in a company's evolution is something we all aspire to do.

If you look at, I believe four years from now, if we're sitting here at the end of the decade saying, "Gosh, Mike, remember when we were at the Marriott Marquis in New York in 2026, and I asked you that question?" We're going to have multiple products on the market. IBSRELA and XPHOZAH are going to continue the growth that they're on, and then some. CIC will be approved. We'll be treating all the patients with CIC and IBS-C who are failing, 77% of which we know are underserved by the current products on the market, and other products that we're doing the same thing. Our novel way of commercializing, we pay attention to the dynamics of payers. We look at all these things and make maybe non-traditional, but I think good for the business decisions and ultimately for the patients that we serve.

I think we'll be talking about multiple products beyond the two here. How many that is, I don't know, but we're going to be able to afford to do a lot.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah.

Mike Raab
CEO, Ardelyx

Sue, do you have anything to add?

Sue Hohenleitner
CFO, Ardelyx

I think that was well said. Thanks.

Bob Klingenberger
Executive Director, Morgan Stanley

Great. Well, thank you both for being here. I think we're on time. Bob, thank you very much.

Mike Raab
CEO, Ardelyx

Thank you.

Sue Hohenleitner
CFO, Ardelyx

Thank you.

Bob Klingenberger
Executive Director, Morgan Stanley

Yeah. Thank you.

Sue Hohenleitner
CFO, Ardelyx

Thanks for the partnership.